70-731 - Laserfiche WebLink

Home Browse Search

�r FOR OFFICE USE: APPLICATION FOR SANITA'T'ION PERMIT �� Permit No, �Q - - �" - ----------- t__"""" ----- �° ,,. �,.. (Complete in Triplicate) ------------------------ -------------- p Date Issued This Permit Expires i Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION 1 Phone ------------------------------------ ,,��// �j�/ 1 ------------------------------ -------- Owner's Name �t'� / � - ---- --- Address _-___ ___ _. _ -- -- --- 3 ��'� City ----------------------------- - ------------------------------------------- Address ---------- --- ------------- ---- `- ---- ��.E -=-------.License # _ Phone/5W7- _ ---•-- Contractor's Name ... _��-��•= --- Installation will serve: Residence Z Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- Number of living units:--/------- Number of bedrooms ---.C"----Garbage Grinder Lot Size Water Supply: Public System and name --------------------- -----------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe [ Fill Ma#erial ------------ If yes,type --------------------- ------ {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] f ee k ' �T l Liquid Depthth __. ..<__-_-_-_-__r__-_ ______Size PACKAGE TREATMENT SEPTIC TANK ( No. Compartmen?� TyPe� -- MaterialCa acitY C dts __2�----------- ----------- Foundation - - ------- Distance to nearest: Well Q ---- LEACHING LINE No. of Lines ---------/------------ Length of each line----1670-------------- Total Length .-----'I-ffl?-__ ------ 'D' Box ��J-- Type Filter Material 6061K-----Depth Filter Material - _--------'-`------------------------•- r -------- Pro er Line "S --------•----" Distance to nearest: Well _57- ------------ Foundation - ----.- P tY t ' ► No ❑ SEEPAGE PIT [ Depth - _ 5 �" Diameter " ___--_____ Number -- J------------------- Rock Filled Yes y /i f -- Water Table Depth _-��p-------------------- -------------Rock Size -�„?. -- - _ I Distance to nearest: Well -----,� -----------• ---------Foundation ----f 0----"""" Prop. Line -----5•-s._--.--- REPAIR/ADDITION(Prev. Sanitation Permit# --------------:------------------------------ Date --------------- Septic Tank (Specify Requirements) ------------------- ---"---------------------- fDisposal Field (Specify Requirements) ---- -------------------- •------------------------------------------------------------------------------------------------------ - -----------I------------------------ ---------------------------- -------------------- ------------------------------ -- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Dome owner or licen- r sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner ' as to become subject to Workman's Compensation laws of California." Signed ------------------- ----------------------------------------- Owner ' Title ---------- By --------------- -- ----- - ------- --- k ( ther th owner) , Jr FOR DEPARTMENT USE ONLY e� APPLICATION ACCEPTED BY -------- DATE -/ Z7- 74 BUILDING PERMIT ISSUED ------------------- ------------- - ---- DATE ADDITIONAL COMME=NTS --------------------------- -- -------•-------- - i ---------------------- --------- ----------------------------------- -------- ---------------------------------------- t ------------------- ------------------------------------------------------------------------------------------------------------------------- - - ---- -- ----------------------- ---- -- ------------------------ Dat b - - - -=------- Final Inspection SAN JOAQUIN LOCAL HEALTH DISTRICT F 14 4 1.'6B Rev. 5M